GLYCOLAZ BOWEL PREARATION FOR COLONOSCOPY

The purpose of the following instructions is to provide good bowel preparation prior to colonoscopy to enhance the quality and safety of the examination. Failure to comply with these instructions may result in having to repeat the bowel Preparation and reattempt colonoscopy at a later date. If questions arise regarding the bowel preparation please do not hesitate to contact the office and resolve these.

1. Avoid aspirin for one week prior to the examination aspirin may contribute to bleeding problems following biopsy or polyp removal.
2. Avoid other arthritis medications for 74 hours prior to the examination these agents may also increase the likelihood of bleeding, but their effect is reversible with avoidance of the medication for several hours. No steroidal anti-inflammatory dtrugs (NSAID's) suck as Ibuprofen, Aleve, Motrin, Daypro, Advil, Vioxx, Celebrex, Tylenol is okay.
3. If you are taking an iron preparation, please discontinue it two or three days prior to the scheduled examination.
4. Please continue all medications that you are taking with the exception of aspirin, Coumadin, iron, and arthritis medications as noted above. If you are taking Insulin or diabetes pills, please get special instructions from Dr. Cook, Dr. Davis, Dravens, or their nurse.
5. If you are taking Coumadin, discontinue dose on __________________________________ and get lab drawn on _________________________________.
6. Since sedation is used during the examination it will be necessaries for you to have a friend or family member drive you home after the exam.

BOWEL PREP

On ___________________only clear liquids may be taken for breakfast, lunch and dinner (clear liquids include: water, coffee, tea, soda pop, clear fruit juice apple, grape, cranberry; bouillon, plain jell-o, Gatorade. NO SOLID FOODS, MILK OR MILK PRODUCTS ALLOWED. NOTHING RED.

On ___________________at_________________ take 4 bisacodyl tablets with 8 oz. of water.

On ___________________at_________________ take one reglan 10 mg. tablet. Start Glycolax preparation at ______. Dissolve entire 255 gm. bottle of Glycolax in 2 quarts (8 coups) of clear liquid of your choice. Drink one (8 oz.) glass every 15 minutes until the 2 quarts are completely gone. This will take 2 hours to complete

Only drink clear liquids until ___________________________________. IF YOU TAKE HEART, LUNG, OR BLOOD PRESSURE MEDICATION IN THE MORNING, PLEASE BE SURE TO TAKE YOUR MEDICATION BEFORE YOU COME TO THE HOSPITAL/ENDO CENTER.

Appear for examination at _____________________________________.

NOTE: IF YOU CANCEL YOUR PROCEDURE WITHIN 24 HOURS OF SCHEDULED TIME, YOU WILL BE CHARGED $100 00




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